46 ANALYSIS OF DISTURBANCES OF METABOLISM 



But also the negative results of many investigations which showed nor- 

 mal or almost normal absorption in such pathologic states— conditions in 

 which with a certain degree of justice it might have been supposed that more 

 serious disturbances were present— have given a basis of support for the 

 dietetic treatment of such cases, and have shown the fallacy of many diet 

 lists based upon erroneous ideas. 



I refer to the excellent monograph of Ad. Schmidt and J. Strassburger/ 

 in which the results of their researches in this subject are compiled, and I' 

 shall limit myself to mentioning a few researches. 



The mal-assimilation of food which Fr. Miiller found in patients with 

 stasis of bile is limited almost exclusively to fai. Miiller found in the feces 

 of his patients fat amounting to 87.4 per cent, (against 32 per cent, in the 

 healthy). The loss in fat often amounted to 50 to 70 per cent, of the fat 

 administered as food. 



The same decided decrease of fat absorption was afterward observed in 

 occlusion of the pancreatic juice from the intestine without complications 

 (Deucher).^ In a case of carcinoma of the head of the pancreas, in which no 

 stasis of bile was present, only 17 per cent, of the fat introduced was absorbed; 

 therefore, the simultaneous action of pancreatic juice and bile is necessary 

 for a sufficient absorption of fat in man. 



On the other hand, it appears from the reports of investigations that 

 neither bile nor pancreatic juice is necessary for the complete spUUing up of 

 fats in the intestinal canal. Not only the fatty stools of the jaundiced patient 

 (Fr. Miiller), but also (according to Deucher) the feces in occlusion of the 

 pancreatic duct contain fat which is chiefly in a split-up form (up to 80 per 

 cent.) ; therefore, Deucher teaches that we cannot count upon the absence of 

 free fatty acids in the feces as evidence of disturbances in the pancreatic 

 function. 



Predominance of free fatty acids,- naturally, not at the cost of the neutral 

 fats, but, on the contrary, at the expense of the soaps (Deucher), means pre- 

 sumably a decrease or absence of the pancreatic juice secretion. 



By others ^ in individual cases, a lessened fat splitting has also been ob- 

 served in connection with occlusion of the pancreatic juice from the intes- 

 tine. Volhard * has shown that, although the decomposition of neutral fats 

 is primarily the function of the pancreas, in cases of occlusion of the pan- 

 creatic juice, fat splitting occurs not only through the action of bacteria, but 

 also through the action of the gastric juice which also contains a fat splitting 

 ferment. There is need of further investigations with due consideration of 

 this factor. 



1 Ad. Schmidt und J. Strasshiirger, " Die Faces des Mensehen," Bonn, 1901. ' 



2 Deucher, " Stoffwechseluntersuchungen bei Verschluss des Ductus panoreaticus." 

 Oorrespondenzbl. f. Schweizer Aerzte, 1898, Nr. 11. 



s Fr. Miiller, loc. cit., Weintraud, " Die Bedeutung des quantitativen Stoffwechsel- 

 versuches fiir die Diagnostik innerer Krankheiten, insbesondere von Pankreaserkrank- 

 ungen." Die Heilkunde, 1898, Heft 2. 



* Volhard, " Ueber das fettspaltende Ferment des Magens." Zeitschr. f. klin. Med., 

 1901, Bd. xliii, p. 397. 



